One unexpected outcome of the COVID-19 pandemic is the upsurge in telemedicine. To be sure, the best medicine always will be a caring, face-to-face visit with a familiar provider, but today, as Hawaii is sheltering in place, cases of the coronavirus are quickly rising and many doctor’s offices are closed or difficult to contact. In view of the fact that Hawaii already had a severe doctor shortage before COVID, finding a new doctor may seem like a daunting task once care has lapsed.

In an effort to optimize the safety of patients and providers in response to COVID, some clinics have initiated remote visits. Although the technology for videoconferencing has been around for many years, the bottleneck for medical providers until now has been the issue of insurance reimbursement. However due to COVID, effective March 6, Medicare announced that it would cover telemedicine visits at the same rate as in-clinic visits if encounters include audio/video and take place in real time. Other carriers have since followed suit.

Literally overnight, Manakai O Malama, an integrative clinic, began to organize telemedicine visits not only for conventional medical providers, but also for psychology, sleep medicine, physical therapy, occupational therapy, naturopathic medicine and even acupuncture and traditional Chinese medicine. Although the need for information, testing and treatment for COVID is rapidly accelerating, we also maintain enough provider capacity to care for new and existing patients for non-COVID health issues. There is now an influx of individuals without a current medical provider. The mandate to “shelter in place” makes the telemedicine option particularly relevant.

Many now also seek remote care in particular for psychological services. Anxiety and depression are not uncommon as we face the prospect of not only falling ill to the virus, but also having to confront the economic impact of unemployment and business losses. Many people feel socially disconnected as a result of physical distancing, and our kupuna are at higher risk during this time. What may be less obvious is the emotional challenge of spending so much time at home with ohana. With parents off work, keiki off school and social gatherings and travel at a bare minimum, stress levels can rise. The cessation of sports activities is also difficult for both athletes and spectators. There is only so much streaming and gaming one can do, and hours of scary news on TV also ends up taking its toll

Sleep medicine requires a multifaceted work flow, but it too has been reorganized at Manakai to offer a remote-only option, where patients first obtain a telemedicine consult and are then sent a disposable home sleep study unit. Results are reported remotely and therapeutic equipment to treat sleep apnea can be sent to the home to ensure restful sleep. Untreated sleep apnea places people at risk for weight gain, stroke, heart attack and depression. Criteria to obtain a sleep study may include snoring and nonrestorative sleep.

You might be surprised to know that other health services also have been allocated telemedicine billing codes. Manakai’s physical therapists now offer rehabilitation via telemedicine, and our occupational therapists offer life management skills for depression, obesity, diabetes, traumatic brain injury and sleep issues. Even the acupuncture department can provide telemedicine that includes guidance on stimulation of acupuncture points, lifestyle and traditional Chinese herbal medicines.

Telemedicine is destined to become part of the new normal, which is a good thing if used appropriately by patient and provider. While the rule changes that empowered remote visits were originally intended to be temporary, they are likely here to stay. Once COVID passes, and eventually it will, many still will prefer to use it whenever possible. Unless it is necessary, why take the time to leave work, drive through traffic and pay for parking when a telemedicine visit will do?

On the road ahead, our lifestyles will be increasingly filled with options for remote activity that include not only health care but also communication, education, entertainment and shopping. We are ultimately social creatures however, and need to be together to thrive. As the convenience of technology enables more of our activities to happen at a distance, the human spirit will seek ever more creative ways to embrace and nourish our relationships with one another.

Ira “Kawika” Zunin, MD, MPH, MBA, is a practicing physician. He is medical director of Manakai O Malama Integrative Healthcare Group and Rehabilitation Center (manakaiomalama.com). Please submit your questions to info@manakaiomalama.com